Nipple reconstruction

Example of a custom made stick-on nipple

Overview

Mastectomy usually means removal of the whole breast including the nipple and areola (the darker area of skin around the nipple), but it is possible to have the nipple reconstructed. It is usually done a few months after the breast reconstruction to give the new breast time to settle into its permanent position.

A reconstructed nipple can improve the appearance of your new breast, but it won't feel the same as a natural nipple. It has none of the normal nerves that allow it to rise (become erect) or flatten in response to touch or temperature.

Giving your new breast a nipple can be another stage in creating a breast that looks as natural as possible. On the other hand, you may be quite happy with your reconstructed breast and choose not to have nipple reconstruction. Or you may decide to use stick-on nipples that can be custom-made, sometimes by the hospital, to match the natural nipple or bought quite cheaply, ready-made.

There are several ways of reconstructing a nipple, so you may want to discuss different options with your surgeon. At the RUH in Bath we frequently undertake the procedure of nipple reconstruction and areola tattoo. These are normally undertaken as two separate procedures, beginning with nipple reconstruction.

Nipple Reconstruction

Nipple reconstruction is undertaken under local anaesthetic as a day case procedure. A flap of skin on the front of the breast is mobilised and moulded to create a nipple prominence, then sutured carefully together. This takes in the region of about 30-40 minutes. Dressings are applied and are required to be in place for two to three weeks afterwards.

Most patients do not experience post operative problems but some may do so; such as delayed wound healing, a wound infection or even partial or total loss of the reconstructed nipple.

Initially the new nipple is quite prominent and swollen but over the course of the following months and years it decreases significantly in size, such that at the end of the day the projection may be quite minimal. Nevertheless, it helps to create the illusion of a nipple.

Nipple Tattoo

A few months after the procedure of nipple reconstruction has been undertaken and after the wounds have healed we would be able to undertake an areola tattoo in the breast unit.

Some patient's may not require or desire the tattoo. Conversely, some may prefer a tattoo without a nipple reconstruction, especially for those whose nipple on the other breast is not at all prominent.

The tattoo is undertaken in the breast reconstruction clinic at the RUH. It takes in the region of about 20 – 30 minutes to perform.

A rapidly vibrating needle impregnates a small amount of pigment in to the skin where the illusion of an areola is to be created. This procedure is slightly uncomfortable but most patients do not require the use of any local anaesthetic.

During the procedure we try to make a colour and size match with the areola on the other breast. To create such an effect we often have to repeat the tattoo on two or more occasions, especially to achieve even pigment uptake.

However, it is impossible to make this match completely even and symmetrical. Nevertheless, this procedure can often enhance and improve the final cosmetic result of a breast reconstruction by giving a more definite visual focus to the breast and making it seem more realistic.

Lastly, it is important to understand that the tattoo often fades with the passage of time, so that the tattoo may need to be repeated.